Organization
KYLE PEDIATRIC DENTAL
Active
Other names
Lone Star Pediatric Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY MONTGOMERY D.M.D. (PRESIDENT)
(512) 574-6923
Entity
Organization
Contact information
Practice address
575 E FM 150, SUITE P, KYLE, TX 78640-6200
(512) 442-4338
Mailing address
2700 S 1ST ST, AUSTIN, TX 78704-5421
(512) 442-4338
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
24217
TX
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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